CT and MRI can also evaluate degree of displacement and fracture pattern

Bone scan has high sensitivity (99 percent), but found to have low specificity (86 percent)(Mallee 2015)

ED Management

Non-displaced

Patients should be placed in a short-arm thumb spica splint with the hand in “wine glass position” (slight dorsiflexion at wrist, digits in slight flexion)

Follow-up with an orthopedist in 14 days for repeat x-rays and possible transition to cast

Displaced or unstable fractures should be placed in a long arm thumb spica splint and referred to hand surgery follow-up as early as possible

Due to high rate of false-negative x-rays in the immediate post-injury period, patients with snuffbox tenderness on exam or suspected fracture should be managed as having a non-displaced fracture due to significant complications that can occur

Scaphoid Fracture

The scaphoid is the most commonly fractured carpal bone.Always consider this injury in a patient with a fall on an outstretched hand

Immediately after injury, as many as 20% of scaphoid fractures may be missed on x-ray even when dedicated scaphoid films are obtained

Scaphoid fractures are a “can’t miss” ED diagnosis due to the high morbidity associated with their complications.Treat clinically suspected fractures (e.g. patients with snuffbox tenderness) as having non-displaced fractures, even in the setting of negative x-rays